HomeMy WebLinkAbout1272 MARY DUNN ROAD - Health 1272 Mary Dunn Road
Barnstable
A= 339-007
i6
V
TOWN OF BARNSTABLE
LOCATION V ,0 G�.�1?9 SEWAGEal)Cl- �2 d
.VILLAGE�,4_ /P�S'�,��,C� ASSESSOR'S MAP&PARCEL 3Jy," 7
INSTALLERS NAME&PHONE NO. // /�17/:�1� Lrd �Ij"
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) ,�rd10 CAf ARat size) o2 `�- (Y 1.2,
NO.OFBEDROOMS J
OWNER 1.L / C
PERMIT DATE: ?/IS COMPLIANCE DATE: t
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
r
within 300 feet of lea c ' g facility Feet
FURNISHED BY Lys'
.f 4 '
IA
Ll
lil / 4 j6r
- �®
.1 � .JT,�O � c!J 1�
? 31.`/ � ,6 7 j` D �
ooK3016
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS Yes
p YiC tiOn for i( aY *_ p 6tem Cow5trUCtton Permit
Application for a Permit to Construct O Repair Upgrade O Abandon O ❑Complete System ❑Individual Components
Locatioy Address or Lot No %t- 1 1 u rvfv + ok Owner's Name,Address,and Tel N
Assessor's Map/Parcel 07 1�(Y
Installer's Dame,Address,and Tel.No. Designer' Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 30 gpd Design flow provided gpd
Plan Date G 4r�A 6 Number of sheets Revision Date
Title
Size of Septic Tank /, no Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
s
Signed Date
Application Approved by t Date �U
Application Disapproved by: Date
for the following reasons
Permit No. d 0 Date Issued 7- 2-5-OK
_ w ,
o .
No. ". ',:: 4 Fee
/
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for Mioonl *raem Cowaruction Permit —�
Application for a Permit to Construct( ) Repair(t Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. M r O u rvfv l
Owner's Name,Address,and Tel.No.
A.)- ?0�_ , .mod 0 'd..)-�,-,�, ✓rr' -4f eve J,r
Assessor's Map/Parcel :7 4j. 0 7 I A CA
Y
Installer's Name,Address,and Tel.No. Designer's Name,Add�esss'and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 74,-� �3 3C) gpd Design flow provided ,� gpd
Plan Date , ,f ,ei 1016 Number of sheets Revision Date
r
Title
Size of Septic Tank Type of S.A.S.. <e&CD oe ,� r'•/fit.t�/fp
a V �.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement: -
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal"system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this
Board of Health.
Signed 1 C---, (� ten. Date
Application Approved by ir,. , � .1 Date 5-O {
Application Disapproved by: / Date
for the following reasons
/
Permit No. .0 d g— r�?o-.6 Date Issued 7" 2 3 d p
———————————THE COMMONWEALTH OF MASSACHUSETTS
n
BARNSTABLE, MASSACHUSETTS t.
(Certificate of Compliance
THIS IS TO CERTIFY,that the tin-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( )
Abandoned( )by l
at 1�-7 9" K4-t V-�. (}�.�•- has been constructed in accordance 9 .
with the provisions of Title 5 and the for Disposal System Construction Permit No. 2A 0 T `3 a 6 dated -74 j—O
Installer Designer
#bedrooms Approved design flow 31-/ 3 gpd
The issuance of this permit shall not be construed as a guarantee that the system will function ads designed.
Date Inspector
--------------------------------------------
No. ( 30,6 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
1=i5poga[ ,pgtem Construction Permit
Permission is hereby granted to Construct( ) Re aim r ( ) Upgrade ( ) Abandon (p )�f
System located at 1 Z-1 I `� �( �," o' l�,�,,n•�.t�Lt.�C,P
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must r-m be completed within three years of the date of this_peit.
`
Date '7 ' 3 ` 6 1( Approved by --�
•� h
' ' a
i
,r— Town of Barnstable BaSta'''e
�pF THE Tp�\
Regulatory Services Department ,
90\1'639:/'"J'1
Public Health Divisionjn
FD MAC 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
March 17, 2008
Lydia Police
1272 Mary Dunn Road
Barnstable, MA 02630
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 1272 Mary Dunn Road, Barnstable MA was last inspected
on March 5, 2008, by Patrick O'Connell, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Tailed" under the guidelines
of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Backup of sewage into facility or system component due to overloaded or clogged.
SAS or cesspool
You are ordered to repair or replace the septic system within Sixty (60) days from the
date of this notification.
A
Failure to repair/replace the septic system within the deadline period pill result in future
enforcement action.
PER ORDER OF TH BOARD OF HEALTH
omas McKean, R.S., CHO
Agent of.the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures\1272 Mary Dunn Road.doc
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1272 Mary Dunn Road
Property Address
Lydia Police - • . C)C)�
Owner Owners Name
information is
required for CurtimagGid 1 g y_ MA March 5, 2008
every page. &y/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. .
Important:When filling out A. General Information
forms on the
computer,use 1. Inspector:
only the tab key
to move your Patrick M. O'Connell
cursor-do not Name of Inspector
use the return
key. Septic Inspection Services Co.
Company Name
r� 189 Cammett Road
Company Address
Marstons Mills MA 02648
City/Town State Zip Code
508-428-1779
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and mantenance�of onsite
sewage disposal systems. I am a DEP approved system inspector pursuant to Section '15340 of
Title 5(310 CMR 15.000). The system:
❑ Passes ❑ Conditionally Passes ® Fa
❑ Needs Further Evaluation by the Local Approving Authority z
ij✓ March 5, 2008
Insp ctor's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
08416 Police.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
Commonwealth of Massachusetts
'Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1272 Mary Dunn Road
Property Address
Lydia Police
Owner information is Owner s Name
required for Cummaquid MA March 5, 2008
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not
determined,"please explain.
❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
08-16 Police.dac•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15
' • \ Commonwealth of
Massachusetts
'Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 1272 Mary Dunn Road
Property Address _
Lydia Police
Owner information is Owner's Name .,
required for Cummaquid MA
every page. Cityrrown March 5, 2008
State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced_
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
0846 Police.doc•0&06
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 1272 Mary Dunn Road
Property Address
Lydia Police
Owner Owners Name
information is
required for Cummaquid MA
every page. CltylTown March 5, 2008
State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
"*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 m q
pp , provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
® ❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
® Liquid depth in cesspool is less than 6" below invert or available volume is less
than_day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
08-46 Police.cloc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1272 Mary Dunn Road
Property Address
Lydia Police
Owner information is Owner s Name
required for Cummaquid MA
every page. City/Town
March 5, 2008
State Zip Code Date of Inspection
B. Certification (Cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water ater supply well with no acceptable water quality asses if the well water analysis. his
system y p ter analysts, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine-what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
08A6 Police.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 1272 Mary Dunn Road
Property Address
L dy is Police
Owner Owners Name
information is
required for Cummaquid MA
every page. Cltyrrown March 5, 2008
State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ ® Were as built plans of the system obtained and examined? If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example,'a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
0846 Police.doc•08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 6 of 15
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w 1272 Mary Dunn Road
Property Address
Lydia Police
Owner Owners Name
information is
required for Cummaquid MA March 5, 2008
every page. Cityrrown State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): N/A Number of bedrooms (actual):
3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No
Laundry system inspected?
❑ Yes ❑ No
Seasonal use?
❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Sump pump? ❑ Yes ® No
Last date of occupancy: Unknown
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203):
Gallons per day Y(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe):
08A6 Police.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 1272 Mary Dunn Road
Property Address
Lydia Police
Owner information is Owner s Name
required for Cummaquid MA
every page. Cityrrown March 5, 2008
State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: None
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons ,
How was quantity pumped determined?
Reason for pumping:
Type of System:
❑ Septic tank, distribution box, soil absorption system
❑ Single cesspool
® Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner)
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
1973
Were sewage odors detected when arriving at the site? ❑ Yes ® No
0846 Police.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
r
Commonwealth of Massachusetts
W Title 5 Official Inspection Form =
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 1272 Mary Dunn Road
Property Address
Lydia Police
Owner Owners Name
information is
required for Cummaguid MA March 5, 2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 3
feet
Material of construction:
® cast iron ❑ 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Septic Tank (locate on site plan):
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
._------------------------------------------------------------------------------------------------------------------------
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
0846 Police.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
aX Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1272 Mary Dunn Road
Property Address
Lydia Police
Owner Owners Name
information is
required for Cummaquid MA March 5, 2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Grease Trap (locate on site plan):
Depth below grade:
feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene
❑ other(explain):
Dimensions:
Scum thickness }
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑concrete ❑ metal ❑ fiberglass ❑ polyethylene
❑ other(explain):
0846 Police.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1272 Mary Dunn Road
Property Address
Lydia Police
Owner Owners Name
information is
required for Cummaquid MA
March ns 2008
every page. City/Town
State Zip Code Date of Inspection
D. System Information (cont.) -
Tight or Holding Tank (cont.)
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping:
Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
F
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
08-46 Police.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1272 Mary Dunn Road
Property Address
Lydia Police
Owner Owners Name
information is
required for Cummaquid MA March 5, 2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System(SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
® overflow cesspool number:
One 6x6 pit.
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Pit was empty at time of inspection, high stains indicate pit has been full to top. System is in hydraulic
failure.
0846 Police.doc•08/06 Title 5 Official Inspection form Subsurface Sewage Disposal System•Page 12 of 15
Commonwealth of Massachusetts
`title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 1272 Mary Dunn Road
Property Address
L dia Police
Owner Owners Name
information is
required for Cummaquid MA
every page. Cityfrown March 5, 2008
State Zip Code bate of Inspection
D. System Information (cont.)
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration One with overflow
Depth—top of liquid to inlet invert 6'
Depth of solids layer o"
Depth of scum layer 0"
Dimensions of cesspool 6x6
Materials of construction Precast
Indication of groundwater inflow ❑ Yes ® No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
High stain line at bottom of overflow pipe
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
08-06 Police.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
Commonwealth of Massachusetts
T Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1272 Mary Dunn Road
Property Address -- -----
Lydia Police
Owner Owner's Name --- - --- -------------
information is
required for Cummaquid
every page. Utyrrown ---- --- MA— March 5, 2008
State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System- Provide a sketch of the sewage disposal system including ties
to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.
Locate where public water supply enters the building.
\ \ \ \ \
♦ \ ♦ \ r r r r r / r / /\r
\r♦J♦/\J\r♦/ r r f r r r r f / r / / r r r r r / r -
/ / f ♦f\/\f\J
♦ ♦ ♦f\!♦J♦J♦J♦J\r\f\r�'V�y}r J r f r r r\f\r\r
50
20 45
32
Commonwealth of Massachusetts
Title 5 Official Inspection Form
• X Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1272 Mary Dunn Road
Property Address
Lydia Police
Owner Owners Name
information is
required for Cummaguid MA _
March 5, 2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to ground water: N/A
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed:
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers - (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
08A6 Police.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15
Town of Barnstable
' pF 1HE)
• y�Py "�, Regulatory Services
"SrABLE Thomas F..Geiler,Director
9$plFo 9. Public Health .Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
This septic system inspection report was completed by a private inspector who is certified
by the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original/copy of this
report; this Division does not warranty the functionality of the septic system in the future
not does this Division agree with any technical observation s and interpretations
contained within this report.
In addition,by receiving this report the Town of Barnstable Health Division`does not
automatically approve the number of bedrooms'listed within this report. The actual
number of bedrooms approved at a particular property would-be listed on the"Disposal
Work Construction Permit".
If you should have any questions regarding this report,please contact the certified Septic
System Inspector who conducted the inspection.
.�FIKE Town of Barnstable i �P
Es P t Q,sr
Public Health Division o �
200 Main Street16219.
z ,
Hyannis, MA 02601 vITNEY BOWES$0521 AR 18 $
O
1
7006 2150 0022 1038 6971 �_j 0004606238 MAILED FROM ZIPCODE 02601
e
v
Pd:C7C L1s 0129 SC 1 02, 04./.20Y OD
RETURN TO SENDER
j UNCLAIMED
UNA®'LE TO FORWARD
cc: 02601400200 *096 9-037 98-1 0--a®
U�t'-:�t► +. �W�2
i
'�SIEN DER:'COMPLETETHIS�SECTmN': COMPLETE THIS SECTIONION .
I
N Complete items 1,2,and 3.Also complete A. Signature
item 4 If Restricted Delivery is desired. ❑Agent
E Print your name and address on the reverse X ❑Addressee ,
so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery
E Attach this card to the back of the mailpiece, I
or on the front if space permits.
1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes I
If YES,enter delivery address below: ❑No
3. Service Type I \
� c,rLS bb m fk C1 2 ke—s o ■Certified Mail ❑Express Mail
❑Registered 0 Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
? I 4. Restricted Delivery?(Extra Fee) ❑Yes
i
2. Article Number
(Transfer from service laben 7 0 0 6 2150 0002 1038 6 9 71
:: !; PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
Town of Barnstable Barnstable
P�pFTHE TO�� AMmerica City; 4 Regulatory Services Department 1 f
BARNSTABLE, : )
MASS
Public Health Division tY�679 �0
�FD MA'S a
M 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 ThomasF.Geller Director
FAX: 508-790-6304 Thomas A.McKean,CHO
March 17, 2008
Lydia Police'-
1272 Mary Dunn Road
Barnstable, MA 02630
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 1272 Mary Dunn Road, Barnstable MA was last inspected
on March 5, 2008,by Patrick O'Connell, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Failed" under the guidelines
of 1995 TITL'E•5 (3310 CMR 15.00) due to the following:
• Backup of sewage into facility or system component due to overloaded or clogged
SAS or cesspool
You are ordered to repair or replace the septic system within Sixty (60) days from the -
date of this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDERjOF TH BOARD OF HEALTH
omas McKean'R S CHO
> �..
�J,o- a y ,.t>� I r ,' tiv � �S F lt€si.
Agent of the Bodrd of Health
es�} tr1, itsJ �j;+`f i.%t• 5..; �r#ta' .r t t ?..,.ir' ? ► O,_ :r
`p y ^*� r•. nti,. i� .�. ' },{:, - • ¢', .i .t-+. - } .i ..tom
Q:\SEPTIC\Letters Septic Inspection Failures\1272 Mary Dunn Road.doc
TOWN OF BARNSTABLE
LOCATION 1 .2 2,2 lt, -X y V u A, SEWAGEA�pc - (-d 4/- ,
VILLAGET ASSESSOR'S MAP&PARCEL ,?,?Y 7
INSTALLERS NAME&PHONE NO.�/�f 1/iS/e �� -��J—O G✓ ® J'
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)� &LO C,#ANX size) V-sf"
NO.OF BEDROOMS
OWNER L L 44 c
PERMIT DATE: DATE:
-2AV-44--
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leac ' g facility) Feet ,J
FURNISHED BY
1
G
I
Town of.Barnstable P#
�.. . .� Department of Regulatory Services
�oF1He A Public Health Division Date
Q, 200 Main Street,Hyannis MA 02601
HAHNSTARM
Eo�tor� Date Scheduledn, 144114s 2'7 Z D0 3 Time Fee Pd. /UV
Soil Suitability Assessment for Sewage Disposal
Performed By:, v.PiMo�sJ ��/LI�, PNi, Witnessed By:�c�a��A / 91 v1,?41V 6�
.. ..:.:.:....... -
AT
Location Address_ ��Fz— /���� ONNN �� Owner's Name wa�1
Address lZ.77i A,24le/ Ov 111.1
Assessor's Map/Parcel: 3 3/( p Q � 1 Engineer's NameG
NEW CONSTRUCTION REPAIR Telephone# 508 " 3 f y/ /9C CU
Land Use ��?S C>3711�'A I--- Slopes(%) 0 — (� Surface Stones - .3 OX,
.Distances from: Open Water Body 7.6`z> ft Possible Wet Area 7 ft Drinking Water Well *o`l ft
Drainage Way 7 2 J ft Property Line ft _ Other /NA ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
Z7 c J ,Z
G w
rJ
v
e M �
m
Parent material(geologic) -5A.V-0 / e,W 2/l'"'& �RSj i s Depth to Bedrock 7 y U
Depth to Groundwater: Standing Water in Hole: /Va Weeping from Pit Face Na
Estimated Seasonal High Groundwater .E<- Z-V . >S U j3d& 0,✓ G2'a�c3
�j r. �
: i:i���!.. .A��:�.�1:..�`t��!..�: �... ..��,._� �:::: I � . .� I"!: ..a.:::.w!�==11!'il
Method Used: fftkaOt00 WA1.� 10�9-1 "�vGown�r�rz3�
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_
..........._. ..:.,....................:..... ...:ME: .. : .....:,. :... .......... ......_......_�.
Observation
Hole# Time at 9" �y•"
� L�/+P531� 7�n�7
Depth of Perc �'t'2 Time at 6"
Start.Pre-soak Time @ o Time(9"-6")
End Pre-soak "NJ
\ Rate Min./Inch Z 3/a C/M E 7��
Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back r
Q:HEALTH/WP/PERCFORM
»>>::.......:....................... .........................................:.......... ...:.> . ........ ....;:.:
Tf
Depi from:;•::.: '.;:.;:.H ........... ::;;oil.Texture:.:;.;... »:<o-;:.;:.......
•••Soil orizon •� S •Soil Color •: •Soil�� �•Other•••
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency*%Gravel)
3 Z
S ..,,� .�s s��3 ✓L 3� � ,a �-
4 All -"�
3o So 1ay2`l�3 /�Ia�s�✓� �2,A��a
...............
............::.:DP.QB:SEItYA' 'I1 .;H: . .L; .............::......... ol .#... .,..,,,.,_..........::::>::>:
Depth from Soil Horizon Soil Texture Soil Color Soil - Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
°
1:2 Al
gA-nN� /�Y/L / C7 SSiv3 ,rz�p�st�
'/ y3 1 �aw.yN y3 /oVe S�� /v Srr✓d yR'Ar3'd
L/ —I-0p e/ S.,ve' S'a"C' I s—, & 62A,IV 66
'I` . (�T, ..r.. .. ...................; 1 ......... :.;:<:: ::::>:::.>:.;
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.%Gravel)
Xi
Depth from Soil Horizon Soil Texture Soti Color Soil Other
Surface(in.),.- (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency,° Gravel)
Flood Insurance Rate Mai; �S`cbv� vooSG -i9_�s
Above 500 year flood boundary No_ Yes t/
Within S00 year boundary No X/ Yes
4 Within 100 year flood boundary No X Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? I3'S
If not,what is the depth of naturally occurring pervious material? /✓A
Certification
n
I certify that on G/6 —q (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,expertise and experience described in 310 CMR 15.017.
Date
Signature ~��
Town of Barnstable
°F114E'° Regulatory Services
4 » Thomas F. Geller,Director
HA"srnHt,E, -
"►ss• Public Health Division
°Teo rnp•+°i Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Officer 508-86274644 Fax: 508-790-6304
Installer &Designer Certification Form
Date: Z= Sewage Permit# r3 ;� Assessor's Map\Parcel 3
Designer: � ✓✓���
J� �owNG h2 Installer: l//f'rvi n/6
Address: Address:_ // ln r'?cr--
ID&1,1/15 pc/zl MA ozb3� 7— ����y��
On �f ��L�a ' was issued a permit to install a
( a e) (installer)
septic system at /a 7Z 144fe// Ac4wN based on a design drawn by "
(address)
/3e,)NA 2 0 Pd, dated 6 - 2 6 01E�
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but.in accordance with State & Local Regulations. Plan.revision or
certified as-built by designer tom.
off` J BERNARD 9Cy
staller s Signature OHN YOUNG G
No-30078
o
c> 9 ARCH•MAR O
c/STE����Q '
SSd7NAl��'�
(Desi er' lgnature) (Affix D tamp Here)
PLEASE TURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED 'UNTIL BOTH THIS FORM AND AS
CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.THANK YOU.
Q:Health/Septic/Designer Certification Form 3-26-04.doc
i
NO�-�''-` 6 A
DESIGN CALCULATIONS
RAILROAD
NUMBER OF BEDROOMS 3MIN
GARBAGE DISPOSAL UNIT NOT ALLOWED 7
DESIGN FLOW
3 BEDROOMS x 110 GAL BR-DA =330 GPD. .D.�.�Pv_IOLAND
/( ) .� LOCUS
REQUIRED SEPTIC TANK CAPACITY 1500�GAL (MIN), ALTHEA
ACTUAL SEPTIC TANK CAPACITY 1500GAL <
LEACHING AREA REQUIREMENTS U.S. 6
---BOTTOM 0.74 GAL/(SF-DA)
--SIDE 0.74 GAL,/(SF-DA)
LEACHING; CAPACITY
((24.5'x12.83') + 2x(24.5'+12.83')x2') `--- BENCHMARK � 4y
_ - O F FOUNDATION 84.93 ' INDEPENDENCE
xO.74 GAL/(SF DAY)- 34,_ GPD
RESERVE 343 GP
LOCATION MAP
SOIL TEST 6" MAX
DATE OF SOIL TEST 06-24-08 80,64 MAX
WITNESSED BY DONNA-f;�TfORTRUI 80.7± EXISTS 1.00' MIN, 3.00' MAX
SOIL EVALUATOR BERNARD J. YOUNG a-� n � iE� ��� �� LEVEL 2 MIN
PERCOLATION RATE `2 MIN, INCH. RISEI, 76.83 MIN 3" SEEDED TOPSOIL, 2°� SLOPE 2 PEASTONE OR
�--- - 77.93 REQ'D 9" MIN, 36" MAX 0.17 „
PERCOLATION12262 - 78.83 MAX 0.93 j FILTER CLOTH
CAB S'.E'RVA.TION HOLE 1 1.25 - - l 79f EXISTS g
ELEV. 78.89 76.80
ELEV. DEPTH HORIZ SOIL TEXTURE COLOR MOTTLING fNFERREG 1.17 C3C3M 76.83
- 76.39 MATCH ���� - �a_µ
76.64 ___l 0.20 76.19 75.98 y`'`:,, :° k v 4 „
0-27 FILL N TO EXISTING ___l 4.00 `=Yy ®�� ® � � �� x4 ' � 3/4 TO 1-1/2
0.83 76.15 =w '.` ` "�=®r-y ��® � ���' ' r:k.w DOUBLE WASHED STONE
76.39 27-30 A LOAMY FINE SAND 10YR3/1 0 CESSPOOL " '-
74.72 30--50 Bw LOAMY FINE SAND 10YR4/6 N "` .` ;..' . :. �.:
73.90
68.89 50-120 C FINE SAND 10YR6/4 E ----� L---- 75.90
DISTRIBUTION BOX
PERCOLATION TEST DONE AT A DEPTH OF 50"-62" : f DB-3 H-10 - 16.50' x 4.83' - 5.01
NO WATER ENCOUNTERED 1500 GALLON SEPTIC TANK 4.00
ST-1500-H-10 6" GRAVEL ON NATIVE SOIL OR 2-500 GAL LEACHING CHAMBERS
OBSERVATION HOLE 2 MECHANICALLY COMPACTED BASE BOTTOM OF TEST HOLE 68.89
ELEV.= 79.37
_ _ -- 24.5' x 12.83' x 2'
ELEV. DEPTH HORIZ SOIL TEXTURE COLOR MOTTLING
78.37 0-12 FILL - N
78.20 12--•14 A LOAMY FINE SAND 10YR2/1 0
75.79 14--43 Bw LOAMY FINE SAND 10YR5/6 N
69.37 43-120 C FINE SAND 10YR7/4 E
NO WATER ENCOUNTERED
✓ ' // 471.86
ITS OF 8',ATERIAOVAL F
�� NS�IITABLE ATERIA IF
ENCOUNTE ' BELO INVERT
✓- [-
0. 0 4.00 83 UdD GROUND
.70 TE PHONE /
L ITS OF 5' MOVAL F - 4.00 GENERAL NOTES
NSUITABLE ATERIA, IF z4..:0 ,� 7 � 1 ALL WORKMANSHIP AND MATERIAL SHALL CONFORM TO 310CMR15
50 LNCOUNTE D BELO J --- AND LOCAL RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL
Pam° p OF SANITARY SEWAGE.
INVERT �t omwnr 7 �{ ,5.45
w., c ssPocrP� --*-a�.4 2) CONTRACTOR_ SHALL VERIFY LOCATION OF EXISTING UTILITIES.
4.00 `~�® U1dD GROUND `�` 00 T CONTACT DIG-SAFE AND LOCAL WATER DEPARTMENT' 3 BUSINESS DAYS
2.83 TO PHONE 0
7.70. y oa
BEFORE BEGINNING CONSTRUCTION.
- , 3) CONTRACTOR SHALL LOCATE ALL EXIST4NG SANITARY FACILITIES ON
4.00 20, PREMISES AND FILL OR REMOVE SAME.
4) ALL COVERS OF SANITARY UNITS SHALL BE BROUGHT TO WITHIN
7 .8 ST#2 92
I 6 OF FINISHED GRADE.
00 24.50 79.3 �° 5) EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY
UNCHANGED.
��/ -.__�� 6) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH
PAVED -- 6,� �r"� DEEDED OR ZONING RESTRICTIONS AND/OR REGULATIONS.
DRIVEWAY 15.25 \ �`'" OWNER/APPLICANT MUST OBTAIN SUCH DETERMINATION FROM
7 B,2 ✓�, �.----------� --- APPROPRIATE AUTHORITY.
(31 d
7 EXCAVATE AND REMOVE UNSUITABLE MATERIAL FOR 5' AROUND
� T � I LEACHING SYSTEM AND REPLACE WITH CLEAN SAND.
0 .00 # ' 8) IF ANY DETAIL OF THIS PLAN IS NOT UNDERSTOOD, CONTACT
0 DESIGN ENGINEER AT 394-1960.
l✓ •92 i`� 9) 48 HOUR NOTICE IS REQUIRED FOR ANY INSPECTION OR
CERTIFICATION REQUIRED.
10) SITE LIES IN FLOOD ZONE C ON FLOOD INSURANCE RATE MAP
12_�2 20. 0 250001 0005C 08-19-85.
41 �67 THIS IS A SEPTIC DESIGN PLAN, DOES
ZL_ NOT CONSTITUTTE A PROPERTY LINE
30 SURVEY, AND CANNOT BE USED TO
ESTABLISH PROPERTY LINES
10 0 10 20 30
SCALE: 1"=20' 4-87.12
APPROVED BY BOARD OF HEALTH
2fRNARD �
JOHN YOUNG
No.30078 DATE: AGENT: ,
ARCH-MAR
___ m■®� e ASSESSORS MAP: 334 PARCEL. 7
20 0 20 40 60 ' �F�� DEED REF: BOOK 1349 PAGE 557
SCALE:1"=40' PLAN REF: BOOK 428 PAGE 68
PROPOSED SEPTIC REPAIR PLAN
KIT DIN BA BR L.NDRY 1 2. TH 1272 MARY DUNN ROAD
BARNSTABLE
LR AS PREPARED FOR:
BR SCALE DATE: JUKE 26, 2008
N�ILLIAM J. POLICE, JR "=20,
FIRST FLOOR UNFINISHED BASEMENT E3E'RNARD J. YOUNG, P,E.
FLOOR PLAN (NTS) BOX 1539, DENNIS"PORT, NIASS 02639 (508) 394-1960
SHEET 1 OF 1